Quantitative pediatric vision screening in primary care settings in Alabama

Association Between Health Insurance and Primary Care Vision Testing Among Children and Adolescents

This survey study assesses rates of vision testing by pediatrician or other primary care practitioners among insured and uninsured persons aged 3 to 17 years.

Amblyopia: A review of unmet needs, current treatment options, and emerging therapies

Amblyopia is a global public health issue with extensive, multifaceted impacts on vision and quality of life (QoL) for both patients and families. Geographical variation exists in the management of amblyopia, with traditional mainstay treatments, optical correction, and fellow eye occlusion most successful when implemented at an early age. In recent years, however, studies demonstrating meaningful improvements in older children and adults have challenged the concept of a complete loss of visual processing plasticity beyond the critical period of visual development, with growing evidence supporting the potential efficacy of emerging, more engaging, binocular therapies in both adults and children. Binocular approaches aim to restore deficits in amblyopia that extend beyond monocular visual acuity impairment, including binocular fusion and visuomotor skills. In view of this, incorporating outcome measures that evaluate the visual performance and functional ability of individuals with amblyopia will provide a clearer understanding of the effect of amblyopia on QoL and a more comprehensive evaluation of amblyopia therapies.

Recent Advances in Screening and Treatment for Amblyopia

Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Vision Screening among Children with Autism Spectrum Disorder

SIGNIFICANCE

Vision problems occur at higher rates in children with autism spectrum disorder (ASD) than in the general population. Some professional organizations recommend that children with neurodevelopmental disorders need comprehensive assessment by eye care professionals rather than vision screening.

METHODS

Data from the 2011 to 2012 National Survey of Children's Health (NSCH) were accessed. Logistic regression was used to evaluate differences between vision screening rates in eye care professionals' offices and other screening locations among children with and without ASD.

RESULTS

Overall, 82.21% (95% confidence interval [CI], 78.35 to 86.06%) of children with ASD were reported to have had a vision screening as defined by the NSCH criteria. Among children younger than 5 years with ASD, 8.87% (95% CI, 1.27 to 16.5%) had a vision screening at a pediatrician's office, 41.1% (95% CI, 20.54 to 61.70%) were screened at school, and 37.62% (95% CI, 9.80 to 55.45%) were examined by an eye care professionals. Among children with ASD older than 5 years, 24.84% (95% CI, 18.42 to 31.26%) were screened at school, 22.24% (95% CI, 17.26 to 27.21%) were screened at the pediatricians' office, and 50.15% (95% CI, 44.22 to 56.08%) were examined by eye care professionals. Based on estimates from NSCH, no children in the U.S. population younger than 5 years with ASD screened in a pediatrician's office were also seen by an eye care provider.

CONCLUSIONS

If the public health goal is to have all children with ASD assessed in an eye care professional's office, data from the NSCH indicate that we as a nation are falling far short of that target.

Parent, Teacher, and Student Perspectives on How Corrective Lenses Improve Child Wellbeing and School Function

OBJECTIVES

Up to 20 % of school-age children have a vision problem identifiable by screening, over 80 % of which can be corrected with glasses. While vision problems are associated with poor school performance, few studies describe whether and how corrective lenses affect academic achievement and health. Further, there are virtually no studies exploring how children with correctable visual deficits, their parents, and teachers perceive the connection between vision care and school function.

METHODS

We conducted a qualitative evaluation of Vision to Learn (VTL), a school-based program providing free corrective lenses to low-income students in Los Angeles. Nine focus groups with students, parents, and teachers from three schools served by VTL explored the relationships between poor vision, receipt of corrective lenses, and school performance and health.

RESULTS

Twenty parents, 25 teachers, and 21 students from three elementary schools participated. Participants described how uncorrected visual deficits reduced students' focus, perseverance, and class participation, affecting academic functioning and psychosocial stress; how receiving corrective lenses improved classroom attention, task persistence, and willingness to practice academic skills; and how serving students in school rather than in clinics increased both access to and use of corrective lenses.

CONCLUSIONS

for Practice Corrective lenses may positively impact families, teachers, and students coping with visual deficits by improving school function and psychosocial wellbeing. Practices that increase ownership and use of glasses, such as serving students in school, may significantly improve both child health and academic performance.

The Use of a Mobile Van for School Vision Screening: Results of 63 841 Evaluations

PURPOSE

To present data from an established mobile screening program for children in the amblyogenic age group using gold-standard examination techniques by eye care professionals.

DESIGN

Retrospective 12-year, cross-sectional study.

METHODS

setting: Single center.

STUDY POPULATION

All children enrolled in pre-kindergarten, kindergarten, and first grades in public schools in Cleveland, Ohio were eligible for evaluations. intervention procedure: An ophthalmic technician and/or optometrist examined children in a customized van that visits all elementary schools. The initial screening included testing of monocular near and distance visual acuity, stereoacuity, ocular alignment, motility, pupils, and external abnormalities. Children meeting the 2003 American Academy of Pediatrics vision screening referral criteria underwent cycloplegic retinoscopy and ophthalmoscopy by the on-site optometrist and received glasses. In addition, these children were referred to pediatric ophthalmology for ongoing care.

MAIN OUTCOME MEASURE

Determination of the proportion of children with refractive errors, amblyopia, and/or strabismus.

RESULTS

Between 2002 and 2014, 63 841 evaluations were performed, representing approximately 55% of eligible children. Overall, 6386 (10.0%) of children met 1 or more referral criteria: 5355 (8.39%) received glasses, 873 (1.37%) had amblyopia, and 1125 (1.76%) had strabismus. Over the 12-year period, there was no statistically significant change in the prevalence of strabismus (1.73%-2.24%, P = .91) or amblyopia (0.9%-2.08%, P = .13) among first grade students.

CONCLUSIONS

Amblyopia, strabismus, and refractive errors are common in young children. During the study period, the rates of amblyopia and strabismus remained stable, indicating the need for continued vision screening and treatment services. A van-based model, traveling directly to schools, appears to be effective in reaching young children in underserved communities.

Efficient referral thresholds in autorefraction-based preschool screening

PURPOSE

To determine economically efficient referral criteria for a preschool vision-screening program using autorefraction.

DESIGN

Retrospective economic evaluation of a screening protocol.

METHODS

Preschoolers in 2 cities received preschool-based Retinomax screening with a standard referral protocol and as-needed comprehensive eye examinations in 2012-2013. Positive predictive values and referral criteria that minimized cost per case detected were derived using data from San Francisco. These modeled referral criteria were then retrospectively tested for cost-effectiveness against other common criteria in Oakland with sensitivity analysis. Cases were defined by American Association for Pediatric Ophthalmology and Strabismus (AAPOS) criteria for amblyopia risk factors. The perspective was a third-party payer. Costs were obtained from a regional insurance provider.

RESULTS

In San Francisco, 3974 children were screened, 631 referred, and 412 examined. Forty-eight percent of referrals, 301 children, met more than 1 of the referral criteria. Positive predictive values ranged from 7% for myopia to 56% for astigmatism. In Oakland, 2359 children were screened and 269 were examined. When applying the modeled referral criteria derived from San Francisco to the population of Oakland, the cost per case detected was $258. When compared in Oakland, the original referral criteria and criteria based on Vision in Preschoolers study cost, respectively, $424 and $371 per additional case detected. The modeled referral criteria had a lower cost per case detected across sensitivity analysis.

CONCLUSIONS

More stringent referral criteria may reduce the cost per case detected in vision screening and allow more at-risk children to be detected with the same financial resources.

The usefulness of the Retinomax autorefractor for childhood screening validated against a Danish preterm cohort examined at the age of 4 years

BACKGROUND AND PURPOSE

Refractometers have gained a foothold in childhood screening for ophthalmic disorders. Given the results of an ophthalmic follow-up of an extremely preterm Danish cohort, the results of the Retinomax autorefractor were further evaluated.

MATERIALS AND METHODS

A nationwide cohort of infants born before gestational age 28 weeks (n=178) and 56 term controls were examined at the age of 4 years. Refraction was given as the cycloplegic Retinomax value. For this study, we analysed the equipment's confidence value on the printout and equipment-induced myopization (as the difference between refraction measured before and after topical cyclopentholate 1%), both items hypothetical with a view to having identified factual ophthalmic deviations.

RESULTS

Thirty-two of 42 eyes with visual acuity ≤0.4 had high Retinomax confidence values (8-9); the Retinomax values were also high in 10 of 12 children with strabismus and lack of stereopsis. Low values (1-6) were recorded in 11 single eyes, 5 of which were normal (false positives). Three children already known to have low vision were unable to cooperate. The overall mean value for equipment-induced myopization was 1.9 D (range, 0-6.87 D). Myopization showed no correlation with visual acuity and corneal curvature, and a weak positive correlation with refractive value disappeared when the myopic outliers were excluded.

CONCLUSIONS

The hand-held Retinomax seemed to be reliable for assessing refraction in 4-year-old children, provided a cycloplegic agent is applied; if used alone, the Retinomax would have missed several cases of ophthalmic deviation during screening. Equipment-induced myopization was not indicative.

Vision and eye health in children 36 to <72 months: proposed data definitions

Supplemental digital content is available in the text.

Purpose

To recommend a standardized approach for measuring progress toward national goals to improve preschool children’s eye health.

Methods

A multidisciplinary panel of experts reviewed existing measures and national vision-related goals during a series of face-to-face meetings and conference calls. The panel used a consensus process, informed by existing data related to delivery of eye and non-eye services to preschool children.

Results

Currently, providers of vision screening and eye examinations lack a system to provide national- or state-level estimates of the proportion of children who receive either a vision screening or an eye examination. The panel developed numerator and denominator definitions to measure rates of children “who completed a vision screening in a medical or community setting using a recommended method, or received an eye examination by an optometrist or ophthalmologist at least once between the ages of 36 to <72 months.” A separate measure for children with neurodevelopmental disorders and measures for eye examination and follow-up were also developed. The panel recommended that these measures be implemented at national, state, and local levels.

Conclusions

Standardized performance measures that include all eye services received by a child are needed at state and national levels to measure progress toward improving preschool children’s eye health.

Vision and eye health in children 36 to <72 months: proposed data system

Supplemental digital content is available in the text.

Purpose

This article provides a rationale for developing an integrated data system for recording vision screening and eye care follow-up outcomes in preschool-aged children. The recommendations were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health at Prevent Blindness and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, US Department of Health and Human Services. Guidance is provided regarding specific elements to be included, as well as the characteristics and architecture of such a data system. Vision screening for preschool-aged children is endorsed by many organizations concerned with children’s health issues. Currently, there is a lack of data on the proportion of children screened and no effective system to ensure that children who fail screenings access appropriate comprehensive eye examinations and follow-up care.

Results

The expansion of currently existing, or developing integrated health information systems, which would include child-level vision screening data, as well as referral records and follow-up diagnosis and treatment, is consistent with the proposed national approach to an integrated health information system (National Health Information Infrastructure). Development of an integrated vision data system will enhance eye health for young children at three different levels: (1) the child level, (2) the health care provider level, and (3) an epidemiological level.

Conclusions

It is critical that the end users, the professionals who screen children and the professionals who provide eye care, be involved in the development and implementation of the proposed integrated data systems. As essential stakeholders invested in ensuring quality eye care for children, this community of professionals should find increasing need and opportunities at local, state, and national levels to contribute to cooperative guidance for data system development.

Objective vision screening in 3-year-old children at a multispecialty practice

BACKGROUND

Vision screening is rarely effectively accomplished for 3-year-olds as part of pediatric well-child examinations. We investigate changes in screening rates and positive predictive values of referrals for 3-year-olds after introducing a photoscreener to a multispecialty group practice.

METHODS

The vision screening results of 3-year-old children undergoing routine well-child examinations between 2007 and 2013 were retrospectively reviewed. From 2007 to 2009, the only method available for vision screening was the Kindergarten Eye Test Chart. From 2010 to 2013 a PlusOptix photoscreener was also available. Rates of vision screening before and after PlusOptix adoption were compared. All children who failed screening were referred to a single pediatric ophthalmologist. Referral rates, follow-up rates, and positive predictive values were determined for PlusOptix photoscreening. Cases were defined by cycloplegic retinoscopy using the 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) vision screening recommendations for amblyopia risk factors.

RESULTS

Of 593 children seen for their 3-year well-child examination between 2007-2009, before introduction of a photoscreener, 59 (10%) received vision screening. The screening rate increased to 766 of 958 (80%) between 2010 and 2013, after introduction of the PlusOptix (P < 0.001). Only 49% of children had a reliable first screening with PlusOptix, and the average number of screenings to obtain a reliable result was 2.39. The positive predictive value of PlusOptix referrals was 51% for amblyopia risk factors and 41% for potential amblyopia.

CONCLUSIONS

Availability of a photoscreener can increase the rate of vision screening for 3-year-old children in a multispecialty practice.

Beyond screening for risk factors: objective detection of strabismus and amblyopia

IMPORTANCE

Commercially available automated vision screening devices assess refractive risk factors, not amblyopia or strabismus, underreferring affected children and overreferring healthy children. Nearly half of affected children are not identified until after age 5 years, when treatment is less effective.

OBJECTIVES

To determine the diagnostic accuracy of the Pediatric Vision Scanner (PVS), a binocular retinal birefringence scanner, to objectively identify strabismus and amblyopia, and to compare retinal birefringence screening with a widely used automated pediatric screening device.

DESIGN, SETTING, AND PARTICIPANTS

Three hundred consecutive preschool children (aged 2-6 years) were screened using the PVS and the SureSight Autorefractor at 2 pediatric ophthalmology private practices. A masked comprehensive pediatric ophthalmic examination provided the gold standard for determining sensitivity and specificity for each screening device.

MAIN OUTCOMES AND MEASURES

The primary outcome was sensitivity and specificity of the PVS for detecting the targeted conditions, strabismus and amblyopia, in children aged 2 to 6 years. Secondary outcomes included the positive and negative likelihood ratios of the PVS for identifying the targeted conditions. In addition, sensitivity, specificity, and positive and negative likelihood ratios of the SureSight Autorefractor for the targeted conditions were assessed in the same cohort of children.

RESULTS

Of the 300 patients, 188 had strabismus only, amblyopia only, or both, and 112 had no strabismus or amblyopia. The sensitivity of the PVS to detect strabismus and amblyopia (0.97; 95% CI, 0.94-1.00) was significantly higher than that of the SureSight Autorefractor (0.74; 95% CI, 0.66-0.83). Specificity of the PVS for strabismus and amblyopia (0.87; 95% CI, 0.80-0.95) was significantly higher than that of the SureSight Autorefractor (0.62; 95% CI, 0.50-0.73).

CONCLUSIONS AND RELEVANCE

The PVS identified children with strabismus and/or amblyopia with high sensitivity, outperforming the SureSight Autorefractor. Accurate, early detection of these conditions could improve long-term vision outcomes of affected preschool children.

Preschool vision screening: update on guidelines and techniques

PURPOSE OF REVIEW

To discuss the current preschool vision screening (PVS) guidelines and review some of the newest vision screening techniques. The different vision screening practices and barriers to screening are discussed.

RECENT FINDINGS

Vision screening guidelines, which have been developed in response to the advances in technology and increased understanding of the developing visual system, have been recently updated by some of the major medical organizations that endorse vision screening. With advances in vision screening technology, there is a growing trend for screening at younger ages.

SUMMARY

PVS has been widely endorsed by various medical organizations as an effective way to detect preventable and treatable vision problems of childhood. Although PVS is widely recommended, actual screening rates remain low. There are several real and perceived barriers to screening which often prevents successful screening programs. Current vision screening guidelines take into account the recent advances in technology. With the development of new devices, vision screening can effectively be performed at younger ages.

Exploring pre-school vision screening in primary care offices in Alabama

PURPOSE

To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices.

METHODS

Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes.

RESULTS

FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement.

CONCLUSIONS

Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.

Amblyopia and binocular vision

Amblyopia is the most common cause of monocular visual loss in children, affecting 1.3%-3.6% of children. Current treatments are effective in reducing the visual acuity deficit but many amblyopic individuals are left with residual visual acuity deficits, ocular motor abnormalities, deficient fine motor skills, and risk for recurrent amblyopia. Using a combination of psychophysical, electrophysiological, imaging, risk factor analysis, and fine motor skill assessment, the primary role of binocular dysfunction in the genesis of amblyopia and the constellation of visual and motor deficits that accompany the visual acuity deficit has been identified. These findings motivated us to evaluate a new, binocular approach to amblyopia treatment with the goals of reducing or eliminating residual and recurrent amblyopia and of improving the deficient ocular motor function and fine motor skills that accompany amblyopia.

Testability of refraction, stereopsis, and other ocular measures in preschool children: the Sydney Paediatric Eye Disease Study

PURPOSE

To determine the testability and lower age limits for applying common eye tests to preschool children.

METHODS

Investigators from the Sydney Paediatric Eye Disease Study examined 2,461 children aged 6 to 72 months between 2007 and 2009. Cycloplegic autorefraction was measured with Retinomax and Canon autorefractors. Ocular biometry was measured by the use of IOLMaster in children aged >30 months. The Randot Preschool Stereoacuity test, Lang-Stereotest II, and the Stereo Smile II test were administered to assess stereoacuity. Fundus photography was performed with the subjects' pupils dilated. Testability was defined as the ability to successfully complete tests in both eyes.

RESULTS

There were 2,189 children with complete data. Most were testable with the Retinomax (71.8%) and Canon (66.0%) autorefractors. Testability improved with age (P for trend <0.0001) for both, and Retinomax achieved >70% testability when a subject was 24 months of age, half the age limit (48 months) found for Canon. IOLMaster was mostly testable in children aged 48+ months. Lang-Stereotest II could be used in children aged 6 months and achieved the greatest testability (94.4%) of all stereotests. White children performed better than children of some other ethnicities on Randot (P = 0.007), with girls performing better than boys (P = 0.01). Bilateral photography was achieved in >70% of preschool children 48 months of age.

CONCLUSIONS

The testability of all measures was strongly age related, with mostly no sex or ethnicity effects found. The handheld Retinomax could be tested in >70% of children aged 24 months, younger than that found for the stationary Canon autorefractor (48 months). Testability measures for most eye tests in this preschool sample are comparable to other preschool studies.

Childhood vision screening in Canada: public health evidence and practice

OBJECTIVES

Best practice guidelines recommend vision testing in children 3 to 5 years of age for the prevention of amblyopia; however, universal vision screening is controversial. In Canada, amblyopia screening can be the responsibility of physicians, optometrists, and/or Public Health. We review the evidence underlying preschool vision screening for amblyopia using an Evidence-based Public Health (EBPH) approach, and consider implications for the Public Health provision of universal screening programs for amblyopia in Canadian jurisdictions in light of present practices.

METHODS

We searched the literature to address each major screening criterion (disease, test, treatment, program requirements) necessary to support preschool vision screening for amblyopia. We also reappraised papers cited in two systematic reviews related to the impact of vision screening. The Chief Medical Officer of Health of each province/territory was sent a short survey asking whether there currently was a Public Health preschool vision screening program in place and if so, for specifics about the program.

RESULTS

An EBPH approach to the literature with respect to the criteria for screening and available intervention studies support amblyopia screening by Public Health. There is a public health divide in amblyopia screening practice in Canada; while some provinces maintain organized programs, others have chosen to delegate the task to other professionals, without a concurrent surveillance function to monitor disparities in uptake.

CONCLUSIONS

Amblyopia deserves attention from Public Health. Efforts should be made to maintain existing programs, and provinces without organized screening programs should reconsider their role in the prevention of inequities with regard to preventable blindness in Canadian children.

Preschool vision testing by health providers in the United States: findings from the 2006-2007 Medical Expenditure Panel Survey

BACKGROUND

Few data are available regarding the rate of preschool vision screening. The purpose of this study is to estimate the current rate of vision testing among children ages 3 through 6 years by any health care provider and to the characterize the children reported to have been tested.

METHODS

We conducted a cross-sectional analysis of the 4,237 children aged 3 through 6 years included in either the 2006 or 2007 Medical Expenditure Panel Survey. Household respondents were asked whether selected children ever had vision testing by a doctor or other health provider. Data were weighted to make estimates representative of the civilian noninstitutionalized population.

RESULTS

Overall, 64.9% (95% CI, 62.9%-66.9%) of children 3 through 6 years of age were reported to have ever had vision testing. The likelihood of previous reported testing increased with age, from 42.9% among 3-year-olds to 79.4% among 6-year-olds (P < 0.001). After adjusting for age, family income, insurance status, whether the child had a regular health care provider, and whether the child had special health care needs, we found that lower odds of testing were reported among non-Hispanic white children (odds ratio [OR], 0.73; 95% CI, 0.55-0.97) and among Hispanic children (OR, 0.62; 95% CI, 0.47-0.82) compared with non-Hispanic black children (OR, 1).

CONCLUSIONS

These findings highlight the gaps in the delivery of preschool vision screening. Improved population-level surveillance of children's vision and methods to track use of vision-related health services are needed to inform policy makers to develop new strategies to improve care.

Efficacy of a web-based intervention to improve and sustain knowledge and screening for amblyopia in primary care settings

PURPOSE

To evaluate the efficacy of a physician-targeted website to improve knowledge and self-reported behavior relevant to strabismus and amblyopia ("vision") in primary care settings.

METHODS

Eligible providers (filing Medicaid claims for at least eight well-child checks at ages 3 or 4 years, 1 year before study enrollment), randomly assigned to control (chlamydia and blood pressure) or vision groups, accessed four web-based educational modules, programmed to present interactive case vignettes with embedded questions and feedback. Each correct response, assigned a value of +1 to a maximum of +7, was used to calculate a summary score per provider. Responses from intervention providers (IPs) at baseline and two follow-up points were compared to responses to vision questions, taken at the end of the study, from control providers (CPs).

RESULTS

Most IPs (57/65) responded at baseline and after the short delay (within 1 hour after baseline for 38 IPs). A subgroup (27 IPs and 42 CPs) completed all vision questions after a long delay averaging 1.8 years. Scores from IPs improved after the short delay (median score, 3 vs. 6; P = 0.0065). Compared to CPs, scores from IPs were similar at baseline (P = 0.6473) and higher after the short-term (P < 0.0001) and long-term (P < 0.05) delay.

CONCLUSIONS

Significant improvements after the short delay demonstrate the efficacy of the website and the potential for accessible, standardized vision education. Although improvements subsided over time, the IPs' scores did not return to baseline levels and were significantly better compared to CPs tested 1 to 3 years later.

Design of a randomized clinical trial to improve rates of amblyopia detection in preschool aged children in primary care settings

PURPOSE

To present the design of a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a web-based intervention for improving provider knowledge about strabismus and amblyopia (S/A) and preschool vision screening (PVS), increase PVS rates, and improve rates of S/A diagnoses made by eye specialists. This is the first cRCT targeting amblyopia prevention.

METHODS

Participants were Medicaid providers in AL, SC, or IL who had Internet access and had filed at least 8 claims for well child visits (WCV) for children ages 3 or 4 years old during a 12-month period before enrollment. Randomization to the Intervention (vision) or Control (blood pressure) arm occurred at the cluster level, defined as the provider (or group of providers) and his/her patients seen for WCVs.

RESULTS

65 Intervention providers (IPs) with 3547 children aged 3 or 4 years, and 71 Control providers (CPs) with 5053 children enrolled. The study will report measures of knowledge and self-reported vision screening behaviors from web-based data. The primary outcomes will be rates of PVS among PCPs, and rates of diagnosis of S/A by eye specialists among the children belonging to Control and Intervention practices.

CONCLUSIONS

We had the same difficulty recruiting PCPs as reported by others. Baseline rates of PVS were low (14.1%), as were rates that S/A were diagnosed by eye providers (1.4%). Our data show a need to improve both primary outcome measures.

Pediatricians' knowledge of, experience with, and comfort levels for cochlear implants in children

PURPOSE

Pediatricians are vital to early hearing detection and intervention programs (EHDIPs) and influence families' decisions and compliance with recommendations for their children having hearing loss. Pediatricians need current, accurate knowledge about diagnostics and treatments including cochlear implants (CIs). This study assessed pediatricians' knowledge about, experience with, and comfort levels for CIs in children.

METHOD

Questionnaires were mailed to a total of 220 pediatricians in 9 cities in Alabama.

RESULTS

Nine questionnaires were undeliverable; of the remaining 211 surveys, 29 were returned (for a response rate of 13.7%), and 26 of those were usable. The results were consistent with other studies. All respondents focused on pediatrics; most were medical homes experienced with children having sensorineural hearing loss. Less than half had counseled families about CIs but had patients using them. Over half had not recommended CIs in 5 years. Several were unsure about current EHDIP goals and CIs in children. Over half were completely uncomfortable determining children's CI candidacy but were comfortable referring them to specialists. About a third were completely uncomfortable discussing CIs with and counseling families about them; most were comfortable with CIs being used in children over other habilitative options.

CONCLUSIONS

These pediatricians demonstrated deficits in current, accurate knowledge about EHDIPs and CIs in children. Audiologists should help them obtain needed information.